The Chair welcomed everyone to the first meeting of the municipal year.  He gave a special welcome to the new committee members, Councillor Doug Taylor and Rohini Simbodyal. 

Apologies for absence were received from Vivien Gildai and for lateness from Dr Alpesh Patel, Chair of the Clinical Commissioning Group. 

On behalf of the board, the Chair thanked the outgoing members, Councillors Christine Hamilton and Chris Bond, for their work and support over the past two years. 

Members are asked to declare any disclosable pecuniary, other pecuniary or non pecuniary interests in the items on the agenda. 

There were no declaration of interests. 

To receive a joint report on the Better Care Fund programme and governance arrangements from Liz Wise, Chief Officer Enfield Clinical Commissioning Group (CCG) and Ray James, Director of Health, Housing and Adult Social Care.

The Board received a report on the Better Care Fund and future governance arrangements.

Bindi Nagra, Assistant Director Strategy and Resources, Health, Housing and Adult Social Care presented the report to the Board highlighting the following:

·       The report has been written to provoke discussion about possible options. 

·       The original proposals for the Better Care Fund were submitted in March/April 2014.  Comments were received and amendments made in May 2014. 

·       The Government announced that there would be a total amount of £3.8billion available for this scheme, but this is not new money: it will come from existing Council and NHS budgets. 

·       It is estimated that Enfield will receive about £20m, including £2m for capital projects. 

·       The aim is to transfer resources from acute to primary care.

·       A quarter of the money will be linked to performance, including reducing hospital admissions in 2015/16.  New proposals are being developed to take account of this. 

·       The final submission will be made in September 2014. 

·       Up until now, governance has been carried out by a short life sub group. The paper puts forward three alternatives for future governance:  merging with the current integrated care board to create a new sub group of the board; merging with the board’s existing Joint Commissioning Sub Group; continuing with the current arrangements.

Comments/Questions

1.               As there was no requirement to make a decision on future governance at this meeting, it was suggested that the options be discussed in more detail at the next Board development session.  Information on the pros and cons of each option should be provided. 

2.               It was very important that the fund’s decision making processes were clearly set out. 

3.               Plans have to be finalised by October 2014, before agreement on commissioning intentions for providers.

4.               Future papers should be simplified, written in Plain English and avoid jargon. 

5.               Ray James apologised for not clearing the final version of the report, as he had just returned from holiday.  He was grateful to officers for their work. 

6.               The revised plan will be signed off by the Government. 

7.               Two governance structures are required: one to agree sign off of the revised plan and another to oversee implementation and delivery. A wider reference group will include key stakeholders.   

8.               The decisions that will need to be taken will become clearer, once Government guidance is received.      

9.               The Chair of the Health and Wellbeing Board will take any necessary decisions in the interim.  These will be reported back to the full board.   

AGREED

1.               To note that the Joint Better Care Fund Plan was submitted by the 4 April 2014 deadline and to note the content of the plan. The existing arrangements would continue until a decision on a new governance option is agreed.

2.               The governance options will be discussed at the next board development session on 9 September 2014.  Papers will be provided in advance and key differences, pros and cons of each option included. 

Members agreed to change the order of the agenda.  Item 4 on the Care Act was considered after item 7 on the SEND reforms.  The order of items in the minutes follows the original agenda order. 

To receive a report from Ray James, Director of Health, Housing and Adult Social Care on the general duties and implications of the Care Act 2014. 

The Board received a report from Ray James, Director of Health, Housing and Adult Social Care, setting out the key requirements of part 1 of the Care Act 2014, the potential impact locally and progress made to implement the provisions in Enfield. 

Bindi Nagra, Assistant Director Strategy and Resources, Health, Housing and Adult Social Care, presented the report to the Board, highlighting the following: 

·       The act received royal ascent in May.  The Council is in the process of reviewing the regulations and working out what it will mean for Enfield.  A summary of Part 1 is included in the report. 

·       It is a very significant piece of health and social care legislation, introducing major changes. 

·       The act is currently out for consultation and the Council is in the process of engaging service users, encouraging them to contribute to the consultation. 

·       The emphasis of health and social care will shift more towards prevention and supporting wellbeing. 

·       It is an expansion of the personalisation agenda, giving people more choice, responsibility and control of and for their own care.  

·       It places responsibility on the council to ensure that people have access to clear information and advice. 

·       It sets health and social care in a wider context, beyond benefits.

·       New national minimum eligibility criteria will be created which should help reduce challenge and will enable people to move more easily between councils. 

·       There will be a new responsibility for councils to respond to the needs of carers. 

·       There is also a raft of reforms in the way care and support will be funded including the introduction of the recommendations from the Dilnot review, placing a cap on care costs, giving a life time allowance of £72,000.

·       A Programme Board has been set up to oversee the changes and to make sure that the Council is compliant with the act from 2015.  The first key task is to analyse the true implications for Enfield and assess the gaps. 

·       The financial gap for council’s is likely to be significant.  

Questions/Comments

1.              The Government are setting a cap on the maximum that anyone will have to pay towards the cost of meeting their needs for care and support.  There will be a new process of assessment.  Currently the maximum amount of money people are allowed to have before the cost of residential care is met is £23,000.  This will change to a maximum of £118,000.  The £72,000 figure only covers care costs.  People will still be liable for residential costs which are approximately £12,500 per year.  It is likely to take 3-4 years before they reach a maximum of £118,000 and all their costs would be met by the state. 

2.              There is a scheme already in existence in Enfield called Keeping House which enables people who are in care to keep possession of their home.  The council will renovate homes and let them out at an affordable rent to those in need. 

3.              The new care act scheme will protect people’s assets, to a certain extent,  ...  view the full minutes text for item 5.

To receive a report from Liz Wise, Chief Officer of the Enfield Clinical Commissioning Group (CCG), on the Clinical Commissioning Group Operating and Strategic plans. 

The Board received a report from Liz Wise, Clinical Commissioning Group (CCG) Chief Officer, on the Clinical Commissioning Group operating and strategic plans. 

Graham McDougall, Head of Commissioning, Integrated and Acute Care at the CCG, presented the report to the Board highlighting the following: 

·       All CCG’s are required to develop an operational plan.  Enfield has produced a draft plan to cover the next two years.  Enfield is also involved in producing a five year strategic plan at the North Central London level. 

·       The trajectories in the operating plan are based on 7 key ambitions.  They align with the trajectories in the Health and Wellbeing Strategy, the CCG Operating Plan and the Better Care Fund. 

·       There is a quality premium concerning access to services and recovery rates. 

·       NHS England had asked the CCG to review the trajectories for IAPT (Improving Access to Psychological Theories) and dementia diagnosis in the original submission. 

·       Reporting of medication errors was also subject to a quality premium.  In Enfield reporting would need to increase by 30% to bring levels up to the London average within peer groups.  The CCG have agreed a target to achieve this over two years at 15% at year. 

·       Much relates to the activity of the acute providers, including the need to reduce emergency admissions across the three acute trusts. 

·       The strategic plan is based upon the activity of the five North Central London Boroughs.  It has been put together by a strategic planning group including representatives from all the boroughs. 

·       NHS England has expressed some anxieties about the initial submission.  More detailed work will be needed to address the challenges and the plan will be resubmitted in September 2014.  The boroughs will need to be more creative about how they work together to meet growing demand and the Nicholson Challenge; addressing rising costs at a time of a continuing reduction in the money available for services.

·       Strategic planning is being carried out to try and bridge this gap and structural interventions put in place including value based commissioning based on outcomes.

·       Improving urgent care so that 95% of people are seen within 4 hours is a significant focus.  There are currently issues at North Middlesex but these are being addressed through a tri partite agreement between the five boroughs, NHS England and Monitor.  There is currently an issue delivering elective care within 18 weeks from the point of GP referral.  It will take time before benefits are realised. 

·       The Royal Free Hospital acquisition of Barnet and Chase Farm will enable Enfield to improve clinical pathways and the quality of care for patients. 

·       Primary Care has been reorganised into a four networks across Enfield.  Work is beginning on jointly commissioned integrated services to manage particular populations, such as people with diabetes.  Working at a network level will enable much wider, more effective interventions.

·       Work on the QIPP (Quality Innovation Productivity and Prevention) financial plan to maintain the sustainability of the North Central London groups is continuing.  There is a  ...  view the full minutes text for item 6.

To receive a report from Andrew Fraser, Director of Schools and Children’s Services on the SEND (Special Educational Needs and Disabilities) reforms. 

The Board received a report from Andrew Fraser, Director of Schools and Children’s Services on the SEND (Special Educational Needs and Disabilities) Reforms. 

Janet Leach (Head of Services for Disabled Children) presented the report to members, highlighting the following: 

·       The Children’s Act 2014 introduces one of the biggest changes to special education needs for many years.  The report provides an overview of these changes.

·       The agenda is challenging, with implementation starting in September 2014.  The steps for transition from the old to the new system are prescriptive. 

·       Statements are being replaced with Education, Health and Care Plans, which is a more holistic approach, they will also be extended to cover young people from 0 to 25 years of age. 

·       Currently 1,400 young people in Enfield are subject to a statement. 

·       A new SEN Code of Practice has been produced and is due to be signed off shortly. 

·       Young people will be given personal budgets.  Eligibility will be subject to a clear process depending on what funding is available.  People will only be able to request a budget when they have an agreed plan.  Agreeing a plan can take 20 weeks. 

·       There is also a requirement for setting out a local offer, by 1 September 2014, including the range of services available in Enfield. This will contain information about criteria, waiting times and access.

·       A clear mediation process for dealing with disputes will be introduced.  A contract will be agreed to provide an independent mediation service across the North London Boroughs. 

·       Young people will gain the legal right to express a preference for state academies, free schools and further education colleges as well as maintained, mainstream and special schools. 

·       Enfield has been piloting the new reforms with 12 families to see how they will work in practice and how services can best be commissioned. It will still be possible to make block bookings in some areas.  A myth buster leaflet is being produced to reassure people. 

·       Outcomes are improving.  There will be guidance around developing the plans, looking at outcomes for the general population and individuals.  Plans will involve identifying the needs to the child, and the required outcomes, small steps to be taken to reach these and the resources required.  A proportion of the resources will be available as a personal budget. 

·       Schools will also have to publish information about what they can provide.  All information will be included on a website. 

·       This will be a massive cultural change putting parents, young people and their families at the heart of the process.  Staff training will be required. 

·       The scheme will begin by prioritising young people in Year 6 – currently 140 children - with a target date for completion of 15 February 2015. 

·       The Government is providing extra funding for independent supporters to help families build resilience.  Enfield has been awarded champion status to share and disseminate good practice. 

Questions/Comments

1.               If people move between boroughs, boroughs will work together to minimise disruption to services. 

2.               It is unlikely that  ...  view the full minutes text for item 7.

To receive the following updates from the Board’s Sub Boards:

a.     Health Improvement Partnership Board

b.     Joint Commissioning Board

c.     Improving Primary Care Board

1.               Health Improvement Partnership Board

The Board received an update report from Dr Shahed Ahmad, Director of Public Health, on the work of the Health Improvement Partnership Board. 

Glenn Stewart, Assistant Director of Public Health, presented the report to the Board, highlighting the following: 

·       The smoking target for four week quitters for 2013/14 was exceeded.

·       In the latest Active People Survey, Enfield came out as the fifth most obese borough in London. 

·       A workshop was held on 26 June 2014 to develop an obesity pathway. 

·       The obesity strategy will be updated in the summer. 

·       Public Health is working with University College London to implement behaviour change models at a population level.

·       The data for the National Childhood Measurement Programme (NCMP) will be submitted in mid-august. 

·       A steering group has been set up to develop the Cycle Enfield proposals. 

·       In Upper Edmonton a diabetes social marketing campaign was implemented at the start of the year and an enhanced diabetes patients’ pathway developed with the CCG.

·       Latest life expectancy figures indicate that there has been an increase in life expectancy of 1.3 and 1.1 years for males and females in Upper Edmonton. 

·       Mental health involvement has included work with mosques, job centres, Council departments, the NHS and community organisations.

·       In child health a school nursing needs assessment has been completed in draft, work has begun on female genital mutilation needs assessment, smoking in young people in the Turkish community, a breast feeding friendly initiative introduced  and 12 parent engagement champions are to be trained to work with the community. 

·       The health check targets for 2013-14 were exceeded as well as the offer targets. 

·       The Annual Public Health report is nearly complete.

·       Information has been uploaded to the public health webpages. 

Questions/Comments

1.               Life expectancy is lower among both males and females in wards in the east of the borough, including Ponders End.  New data from Enfield Chase, Enfield Lock, Ponders End and Jubilee is just out. 

2.               The schemes for increasing life expectancy have not been running for long and the work being done is based on good practice which should have an impact in the long term.  Hypertension and smoking levels are key.  In future focus will be placed on certain at risk populations such as the Turkish smokers. 

3.               One of the benefits of the transfer of public health services to the authority is the ability to target resources more effectively in areas of greatest need.  With a better recall system those who need the most help can be more accurately identified. 

AGREED to note the contents of the report and the appendix. 

2.               Joint Commissioning Board

The Board received the report from Ray James (Director of Health, Housing and Adult Social Care) updating them on the work of the Joint Commissioning Board.

Bindi Nagra (Assistant Director Strategy and Resources – Health, Housing and Adult Social Care) and Graham McDougal (Head of Commissioning, Integrated and Acute Care at the CCG) presented the report to the  ...  view the full minutes text for item 8.

To note that the Board work programme for 2014/15 will be discussed at the development session to be held on 9 September 2014. 

The Board noted that the work programme for 2014/15 will be discussed at the development session on 9 September 2014. 

To receive and agree the minutes of the meeting held on 20 March 2014. 

The minutes of the meeting held on 20 March 2014 were agreed as a correct record. 

To agree the dates set aside for future meetings of the Board: 

·       Thursday 16 October 2014

·       Thursday 11 December 2014

·       Thursday 12 February 2015

·       Tuesday 14 April 2015

To agree the dates for informal development sessions: 

·       Tuesday 9 September 2014

·       Thursday 13 November 2014

·       Thursday 22 January 2015

·       Thursday 12 March 2015

Please note that the dates for future meetings and development sessions have been reversed and differ from those previously sent out to board members. 

AGREED that full board meetings would take place as follows: 

·       Thursday 16 October 2014

·       Thursday 11 December 2014

·       Thursday 12 February 2015

·       Thursday 14 April 2015

AGREED that future development sessions would take place as follows:

·       Tuesday 9 September 2014

·       Thursday 13 November 2014

·       Thursday 22 January 2015

·       Thursday 12 March 2015

All meetings will take place at the Civic Centre at 6.30pm. 

Dr Alpesh Patel, Chair of the Clinical Commissioning Group, announced that he would stepping down from his position on 31 July 2014, as his term of office had come to an end.  A new CCG chair would be elected and would attend future meetings of the board. 

The Chair gave a vote of thanks, on behalf of the board, for his work over the past two years. 

If necessary, to consider passing a resolution under Section 100A(4) of the Local Government Act 1972 excluding the press and public from the meeting for any items of business moved to part 2 of the agenda on the grounds that they involve the likely disclosure of exempt information as defined in those paragraphs of Part 1 of Schedule 12A to the Act (as amended by the Local Government (Access to Information) (Variation) Order 2006).

(There is no part 2 agenda)